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ADVERSITY, QI, AND ACCREDITATION: 18 MONTHS AFTER A PUBLIC HEALTH “TOTAL MAKE-OVER”Paul Khuenert, MS, RN, Public Health Team Director, Robert Wood Johnson Foundation
Adversity, QI and Accreditation: 18 months after a Public Health
‘Total Make-Over'
Paul Kuehnert MS, RNPaul Kuehnert MS, RN
(Former) County Health Officer & Executive Director(Former) County Health Officer & Executive Director
Kane County, IllinoisKane County, Illinois
Public Health Team DirectorPublic Health Team Director
Robert Wood Johnson FoundationRobert Wood Johnson Foundation
“Sweet are the uses of adversity,Which, like the toad, ugly and venomous,Wears yet a precious jewel in his head.”
-Wm Shakespeare
Today’s Presentation
• Background and Context
• Recession of 2008
• Impact on Kane County Health Department
• Strategic Response: 2010 ‘Total Makeover’
• Transfer MCH personal health services
• 50% RIF, Re-organization
• Results to date
• Fiscal
• MCH Services
• Population health
• QI & Accreditation
Kane County, Illinois
• 515,000 residents
• 2nd & 5th largest IL cities
• 70% urban/suburban, 30% rural
• 1/3 of residents are Hispanic
• Second youngest county in Illinois
• Fastest growing segment: 45-64 year olds
Kane County Health Department
• Established by resolution in 1985
• Governance: County Board of 24 & County Chairman
• Annual Budget: $6 Million 62 FTEs
The Problem
The current recession has reduced tax revenue while increasing service demands for
governmental public health
KCHD at Crossroads: June 2010
• Illinois has both cut grants and set a policy of late payment to vendors, including local government
• KCHD has lost $1m in state grant revenue & experienced payment delays up to 200 days
The Opportunity
The recession and the state fiscal crisis demand a strategic organizational response from the Kane
County Health Department
The Strategy
Transform the Kane County Health Department to completely focus on population health:
• Transfer direct client services to 3 FQHCs
• Reduction in workforce by 50%
• Re-organization using PHAB standards as framework
2010 Agency Reorganization
THEN:
•120 FTEs
•50% grant-funded
•Budget: $10 million
•Focus: Mixed, individual-level programs and services &
• population
• focused
NOW:
•60 FTEs
•20% grant-funded
•Budget: $6 million
•Focus: Population-focused health, 10 essential services
•All job descriptions include: QI, population focus, essential services, preparedness & response
New Capacity
New Job Descriptions & Capacity
Re-org Results So Far…
1. Financial sustainability
2. Impact on MCH services
3. Population focused practice
4. QI & Accreditation
1. Financial Sustainability
Financial Sustainability
KCHD CFY 2010 Revenue: $8,882,749
Expend.: $9,536,488
($653,739)
(~50% from Grants)31 total grants26 state grants
122 FTES
KCHD CFY 2011:Revenue: $6,683,413 Expend.: $6,272,263
$411,150
(~20% from Grants)21 total grants17 state grants
60 FTEs
Financial Sustainability
Our FY12 budget:
•Slight increase to revenues
•Added 2.0 FTES
•Projected 2% positive margin
2. Impact on MCH Services
Quarterly Reports: www.Kanehealth.com
Quarterly Reports: www.Kanehealth.com
3. Population Focused Practice
New capacity led to new community assessment and planning process in Kane in 2011-12:
1.Formal partnership with 5 hospitals, mental health board, 2 United Ways~~~additional $$ resources
2.Integrated planning and policy development with County Development and Transportation Departments
3.Alignment: policy, systems & environmental change
2011 Community Health Assessment &Improvement Planning
Why?•Efficient resource use: 9 Kane County agency partnership•KCHD reorganization>>>capacity•Alignment around health needs & priorities
What?•Comprehensive two-part report
• Assessment• Improvement Plan
•9 customized reports•Health integrated in Kane 2040 Plan•Web-based data and source reports
Why?•Efficient resource use: 9 Kane County agency partnership•KCHD reorganization>>>capacity•Alignment around health needs & priorities
What?•Comprehensive two-part report
• Assessment• Improvement Plan
•9 customized reports•Health integrated in Kane 2040 Plan•Web-based data and source reports
Population Focused Practice
4. QI & Accreditation
QI Training Needs
Use of QI Tools
Staff Interest/Engagement
2010-2011 QI Projects
Division/Team Project
OCHR, CHR Section Improve response rates of employee call-down drills.
DP, PHN Section Improve rates of initial high risk infant follow-up visits within compliance levels.
OCHR, Admin Section Improve structured spending of grant funds.
HP, Environmental Health Section
Decrease critical food inspection violations (to decrease instances of FBI).
HP, Community Health Section
Improve pre & post meeting communication in Community Health
DP, Communicable Disease Section
Improve collection & reporting of immunization data
DP, Immunization Section Improve rate of immunization competence for PHNs
KCHD Leadership Team Improve KCHD financial management
Project Results (So Far!)
• Employee call-down drill rates increased from 36% to 88%.
• Vaccine accountability increased from 92% to 100%, decreased from 3 data systems to 1.
• PHNs “competent” (Benner) in delivering immunizations increased from 25% to 100%.
• Awareness of CH meetings and of partnership increased from ~60% to ~90%.
Accreditation Committee & Workgroups
• COMMITTEE
• 16 Leadership Team Members
• 8 CHS-III staff
• CHS-I & CHS-II staff as support, as needed
• WORKGROUPS
• 1 per domain
• Lead: Leadership staff expert (in that area)
• Support: CHS-III staff, Leadership team
– CHS-III: No more than 2-3 domains
PHAB Application Accepted: May, 2012
“Sweet are the uses of adversity,Which, like the toad, ugly and venomous,Wears yet a precious jewel in his head.”
-Wm Shakespeare
Robert Wood Johnson Foundation
Route 1 and College Road East,
P.O. Box 2316,
Princeton, NJ 08543
pkuehnert@rwjf.org
Phone: 609-627-6319
Paul Kuehnert Senior Program Officer & Team Director, Public Health Team
Stay Connected
www.rwjf.org
www.newpublichealth.org
Twitter: @RWJF_PubHealth
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